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Liver and GI Flashcards

1
Q

What are the functions of the Liver?
[4]

A

Amino acid synthesis
Carbohydrate metabolism
Fat metabolism
Protein synthesis

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2
Q

Liver function – carbohydrate metabolism

A

Glycogenesis - the formation of glycogen from glucose

Glycogenolysis - the breakdown of glycogen into glucose

Gluconeogenesis - the synthesis of glucose from certain amino acids, lactate or glycerol

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3
Q

Liver function – fat metabolism

A

cholesterol synthesis, the production of triglycerides

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4
Q

Liver function – protein synthesis

A

Liver produces albumin, coagulation factors I (fibrinogen), II (prothrombin), V, VII, IX, X and XI

The liver breaks down hemoglobin, creating metabolites that are added to bile as pigment (bilirubin and biliverdin).

The liver breaks down toxic substances (e.g., by methylation) and most medicinal products in a process called drug metabolism. Preferably, the toxins are conjugated to avail excretion in bile or urine.

The liver converts ammonia to urea.

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5
Q

Role of albumin

A

retains fluid in vascular compartment

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6
Q

What is bilirubin?

A

Bilirubin is the main bile pigment that is formed from the breakdown of heme in red blood cells.

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7
Q

Why does bilirubin need to be conjugated? How?

A

Bilirubin is in a lipid-insoluble form that must be made water-soluble to be excreted.

The free, or unconjugated, bilirubin is carried by albumin to the liver, where it is converted or conjugated and made water soluble by glucuronyl transferase

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8
Q

What is the difference between direct and indirect bilirubin

A

Direct bilirubin is conjugated with glucuronic acid
Indirect bilirubin is not conjugated to the liver and it attaches to the carrier protein albumin.

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9
Q

What are the clinical manifestations of liver disease?

A

Jaundice
Loss of appetite
Pale stools
Dark urine
Itching
Swelling of the abdomen, ankles and feet
Excessive fatigue
Bruising and easy bleeding
Hepatic coma

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10
Q

Clinical manifestations of liver disease - jaundice

A

Yellow colour comes from bilirubin

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11
Q

Clinical manifestations of liver disease - pale stool

A

occurs when the secretion of bile pigments is blocked due to obstruction in bile duct

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12
Q

Clinical manifestations of liver disease - Itching

A

when bilirubin is deposited in the skin - causes an intense itch

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13
Q

Clinical manifestations of liver disease - swelling

A

due to decreaed osmotic pressure due to decreased albumin hn the blood and therefore accumulation of fluid in tissues

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14
Q

Clinical manifestations of liver disease - dark urine

A

occurs when conjugated bilirubin is excreted in urine

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15
Q

Clinical manifestations of liver disease - bruising and easy bleeding

A

clotting factors are not being produced by liver

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16
Q

Clinical manifestations of liver disease - Hepatic coma

A

failure of liver to remove toxic substances such as ammonia from the blood

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17
Q

Liver function tests

A

Albumin: normal range: 3.9 to 5.0 g/dL
- decreased levels sign of liver failure
Total bilirubin: normal range: 0.1–1.2 mg/dL.
- raised in prehepatic, hepatic, and post hepatic abnormalities

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18
Q

Types of Jaundice

A

pre-hepatic jaundice
intra-hepatic jaundice
post-hepatic jaundice

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19
Q

Pre-hepatic jaundice

A

Occurs when a condition speeds up the breakdown of red blood cells
e.g. malaria, sickle cell anaemia, thalassaemia.

The bilirubin raised in the blood is unconjugated

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20
Q

Intra-hepatic Jaundice

A

causes include: Viral hepatitis, alcoholic hepatitis, paracetamol overdose, leptospiroses and liver cancer.

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21
Q

What is Hepatitis?

A

Inflammation of the liver

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22
Q

How long does acute and chronic hepatitis last?

A

Acute - immune system clears the virus within 6 months

Chronic - infection lasts longer because the immune system is unable to clear the virus

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23
Q

What are the causes of Hepatitis?

A

Drugs
Toxins
Alcohol
Infections (A,B,C,D,E)
Other infections: parasites, bacteria and fungus
Physical damage

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24
Q

What is Hepatitis A?

A

Single stranded RNA virus
Acute infection and provides lifelong immunity.
Incubation period: 30 days average

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25
How is Hepatitis A transmitted?
Fecal contamination in food or water Contaminated shellfish
26
Is Hepatitis A spread through salvia, kissing and sneezing?
no
27
When is a person with hepatitis most contagious?
2 weeks before the person feels unwell
28
What are the clinical features of Hepatitis A?
Fever, malaise and anorexia - 3-6 weeks post incubation Most infections with HAV are anicteric (w/o jaundice) and remain undetected. HAV never peruses a chronic course. There is no carrier state and infection provides lifelong immunity
29
How is Hepatitis A diagnosed?
Anti-HAV IgM suggests acute infection Anti-HAV IgG suggests past infection and is common over the age of 50 Liver enzyme levels may be raised Stool test for the presence of virus
30
What isthe presense of HBeAg in a hosts serum associated with?
High rate of viral replication and infectivity
31
How is Hepatitis A treated?
Rest, fluid intake, and symptom management Most people recover completely and become immune to reinfection
32
How are vaccines for HAV developed?
Developed from formalin-inactivated , cell culture-derived virus. 2 doses, administered 1 month apart
33
Who are Hepatitis A vaccinations recommended to?
travellers to third world countries
34
What is Hepatitis B?
DNA virus - partial double stranded Incubation period: 60-90 days on average Can cause serious diseases
35
How is Hepatitis B transmitted?
Direct contact with blood or bodily fluids
36
Can Hepatitis B be transmitted though food water or casual contact?
No
37
What are the possible outcomes of infection with the Hepatitis B virus (HBV)?
38
What are the types of Hepatitis B?
1. Acute Hepatitis B 2. Fulminant Hepatitis B 3. Chronic Hepatitis 4. Hepatitis B carriers
39
What are the clinical features of Acute Hepatitis B?
Most patients have acute HVB - similar to that produced by HAV - complete recovery and lifelong immunity
40
What are the clinical features of Fulminant Hepatitis B?
Rare. Characterised by massive liver cell necrosis, hepatic failure and high mortality rate.
41
What are the clinical features of chronic hepatitis?
In 5-10% of patients HBs antigenemia does not resolve > infections persists > disease progresses to chronic hepatitis B.
42
What are the clinical features of Hepatitis B carriers?
Elevated serum alanine aminotransferase levels.
43
Who is considered a Hepatitis B carrier?
Individuals who remain HBsAg positive for at least 6 months. Carriers may have chronic hepatitis B.
44
Hepatitis B and pregnancy?
A woman with Hepatitis B can transfer infection to her baby at birth Babies with Hep B can get very sick, can develop chronic infection, cirrhosis or liver cancer Pregnant women should be tested for Hep B All Babies should get Hep B vaccine at birth
45
How is Hepatitis B diagnosed?
Hepatitis surface antigen (HBsAg) screening -- blood test PCR test to detect and measure the amount of HBV DNA ALT and bilirubin levels raised in blood
46
What is the treatment for HBV?
Lamivudine (Epivir), Adefovir (Hepsera), Tenofovir (Viread), Telbivudine
47
Who is vaccination of Hepatitis B given to?
High risk groups
48
What is the dosage of the vaccination for hepatitis B?
Three doses given 1st and 2nd one month apart and 3rd dose 5 months later 95% protective
49
What is the HBV vaccine? How protective is it?
Recombinant HBsAg vaccine 95%
50
Describe the pathogenesis of Hepatitis A & B?
51
What is Hepatitis C?
Positive Single Stranded RNA virus Incubation period: 6-7 weeks on average
52
How is Hepatitis C transmitted?
Shared injection equipment (60%) Blood transfusion Sexual intercourse Mother to baby 10-20% - no identifiable risk factors
53
Is there a vaccine available for Hepatitis C?
No effective vaccine
54
What percentage of patients develop chronic Hepatitis C?
80
55
What is the lifecycle of Hepatitis C Virus?
1. Viral entry 2. viral replication and assembly - HCV genome does not enter through the nucleus RNA replication occurs in the cytoplasm of hepatocytes. 3. release of virus through budding
56
What is the Pathogenesis of the Hepatitis C Virus?
57
How is Hepatitis C diagnosed?
Detection of anti-HCV antibodies Positive antibody test followed by additional testing for the presence of hepatis C virus (PCR) To check for liver function: live enzyme tests or a liver biopsy
58
How is Hepatitis C treated?
combination of Pegylated interferon-alpha-2a OR Pegylated interferon-alpha-2b and ribavirin (aniviral) for a period of 24 or 48 weeks, depending on hepatitis C virus genotype
59
What are the types of alcohol hepatitis?
1. Fatty liver (steatosis) - accumulation of fat within hepatocytes - is irreversible 2. Hepatitis (steatohepatitis) - fatty liver with inflammation can range from mild hepatitis, to severe liver dysfunction with complications 3. Cirrhosis
60
What is cirrhosis?
Characterised by fibrosis (scarring) and structurally abnormal nodules with loss of function
61
What is the cause of cirrhosis?
Caused by many forms of liver diseases and conditions such as hepatitis and chronic alcoholism
62
What can cirrhosis lead to?
Portal hypertension
63
What are the complications of cirrhosis?
Ascites - abnormal build up of fluid in the abdomen Hepatocellular carcinoma
64
What is appendicitis?
Inflammation of the appendix
65
What are the signs and symptoms of appendicitis?
Abdominal pain Anorexia, nausea and vomiting Low grad fever leukocytosis - increased level of leukocytes
66
What are the causes of appendicitis?
Obstruction of the appendix lumen - most commonly faecaliths - less commonly by tumors, mass of works, foreign body
67
Describe the pathogenesis of appendicitis.
1. Luminal obstruction 2. Bacterial stasis and inflammation 3. Distension 4. Ischemia 5. Focal necrosis 6. Perforation
68
How is Appendicitis diagnosed?
High WBC count: 12,000 – 18,000 HCG Negative Signs & symptoms
69
What are the complications of Appendicitis?
Perforation (75% risk at 48h) Abscess Peritonitis Septicaemia
70
What treatments are available for appendicitis?
Antibiotics before surgery Appendectomy in uncomplicated cases Laparotomy – open abdominal surgery Laparoscopic surgery
71
What is the daily production of bilirubin?
250-350mg

Pathology (11 decks)

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